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NPI Code Detail

MEDICARE: MR. DESTIN TROY ATTERBURY SR.

MEDICARE: MR. DESTIN TROY ATTERBURY SR.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerLCSW129853CA
2101YM0800XMental Health CounselorLCSW129853CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
200000000000000OTHERCAUNKNOWN

General Provider Information

NPI Number : 1558803353
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DESTIN TROY ATTERBURY SR.
Provider Business Mailing Address
First Line : 510 S VERMONT AVE FL 17
Second Line :
City : LOS ANGELES
State : CA
Zip : 90020-1912
Country : US
Telephone Number : 323-409-6883
Fax Number : 323-441-8053
Provider Business Practice Location Address
First Line : 2051 MARENGO ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90033-1352
Country : US
Telephone Number : 323-456-5412
Fax Number : 323-441-8053
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/09/2016
Last Update Date : 04/27/2026

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